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ARIZONA STATE SENATE
Fifty-Seventh Legislature, First Regular Session
nonemergency medical transportation; study
Purpose
Requires the Arizona Health Care Cost Containment System (AHCCCS) to contract with an independent consulting firm to conduct a study on the adequacy and appropriateness of the current reimbursement rates for non-emergency medical transport (NEMT) providers and to include the results of the study in AHCCCS's next capitation rate request and reimbursement rate for NEMT providers.
Background
Subject to approval by the Centers for Medicare and Medicaid Services (CMS), nonemergency medical transportation may not be provided except for stretcher vans and ambulance transportation. Prior authorization must be obtained for transportation by stretcher van and for medically necessary ambulance transportation initiated by a physician, but is not required for medically necessary ambulance transportation services rendered to members or eligible persons initiated by dialing 911 or other designated emergency response systems (A.R.S. § 36-2907).
AHCCCS covers medically necessary non-emergency ground and air transportation to and from a required medical service for most recipients. Non-emergency transportation providers must bill the number of trips and the number of loaded miles as units of service on the CMS 1500 claim form. Loaded mileage is the distance traveled, measured in statute miles, with a recipient on board the vehicle and being transported to receive medically necessary covered services (AHCCCS).
A capitation rate is a mode of payment in which the program contractor receives a fixed rate per person notwithstanding the amount of services provided to a member for the delivery of services (A.R.S. § 36-2931).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Allows AHCCCS to receive funding from NEMT providers and other interested enterprises to cover the costs of a NEMT rate reimbursement study.
2. Stipulates that, if sufficient monies are received, AHCCCS must contract with an independent consulting firm to conduct the NEMT rate reimbursement study of the current reimbursement rates for providing outlined medically necessary NEMT for AHCCCS members.
3. Requires the study to review the costs necessary to meet the requirements for transporting members and to collect and maintain records of actual services provided, as required by AHCCCS's policies.
4. Requires the contracted consulting firm, in determining the adequacy of the current reimbursement rates, to examine the costs to NEMT providers associated with delivering services in both rural and urban Arizona, including the programmatic, administrative, technology and indirect costs.
5. Allows AHCCCS to require contracted providers and managed care organizations to provide financial data to AHCCCS to assist in the study.
6. Requires AHCCCS's contracted providers and managed care organizations to provide all data required by AHCCCS as outlined.
7. Requires the study to be completed within one calendar year after AHCCCS receives sufficient monies to complete the study.
8. Requires AHCCCS to submit the study results to the Joint Legislative Budget Committee (JLBC).
9. Requires AHCCCS to include the study results in AHCCCS's next capitation rate request and in the reimbursement rates for NEMT providers immediately following the completion of the study.
10. Stipulates that, if the results of the study are not completely incorporated into the capitation rate, AHCCCS must provide a report to JLBC within 30 days after setting the capitation rates that includes the reasons for any difference between the actual rates and study rates.
11. Becomes effective on the general effective date.
House Action
HHS 2/17/25 DP 11-0-1-0
3rd Read 2/27/25 56-1-3
Prepared by Senate Research
March 17, 2025
MM/KS/AO/slp